Discussions around bodily autonomy have been contentious for a long time, and the restrictions imposed by the COVID-19 pandemic further exacerbated the issue of access to reproductive health services. Within the array of available contraceptive choices, it is crucial to scrutinise the role of self-care in this ongoing conversation as it is vital for India’s vision of expanding contraceptive choices, ensuring equity, and improving service delivery in family planning, aligning it with women’s rights and gender justice.
Over time, India’s family planning program has achieved significant milestones, in terms of wider reach, better service quality, greater variety of contraceptive methods, and financial investments. For instance, the total fertility rate has declined from 3.4 in 1992 to 2.0 in 2019, as reported by Pew Research Center. There has been a significant reduction in unmet needs from 13% to 9%, and the utilisation of reversible methods such as Intrauterine Contraceptive Device (IUCD), pills, condoms, and injectables has also shown an upward trend.
However, despite these sustained endeavors over seven decades, challenges persist: access to a basket of choices remains limited, the method mix remains skewed (37.9% female sterilisation), the unmet needs still remain high, and the socioeconomic gap in the use of family planning methods still prevails. There are a variety of contributing to the skewed method mix, issues around contraceptive use and the prevalence of coercive practices related to contraceptive provision.
Firstly, the role of service providers in enhancing awareness, fueling demand, guiding method selection, and encouraging the adoption of family planning resources has remained essential. It is important to acknowledge that provider bias, which can encompass factors such as the client’s age, parity status, husband’s consent, and marital status, can pose a significant barrier to women’s preferred contraceptive methods (as per a review paper by Solo J, Festin M published on Global Health: Science and Practice). This bias includes the practice of favoring some methods and discouraging others in the absence of a sound medical rationale, as well as failing to ascertain and respect the client’s preference.
Secondly, while family planning policies aim for a shift to modern reversible methods, women often bear the primary responsibility for contraception. Yet, patriarchal control heavily influences contraceptive decisions, making it predominantly a concern for women despite being influenced by men.
This is where the concept of self-care comes in. WHO defines it as “the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a healthcare provider.” Introducing self-care in family planning involves educating and informing clients to autonomously choose a method aligning with their reproductive choices and goals.
The “de-medicalisation of contraception” advocates for empowering individuals to take more control and responsibility for their contraceptive decisions and methods without heavy medical intervention or prescription requirements. In this regard, self-care interventions emerge as a significant pathway to improve sexual and reproductive health rights by granting women the autonomy to decide for themselves, offering the potential to alleviate barriers linked to frequent healthcare visits, method accessibility, and contraceptive usage. Self-care methods have the potential to meet not only the contraceptive requirements of sexually active adults but also address the increasing contraception needs of adolescents. These methods can help reduce unintended pregnancies among adolescents while safeguarding their privacy in this sensitive matter. Moreover, the socio-economic disparities in family planning usage, stemming from limited access and reach, could significantly be reduced if individuals could initiate and continue family planning methods without relying on healthcare workers.
There are already multiple self-care commodities available in the market, like combined oral contraceptive pills, progestin-only pills, emergency contraceptive pills, male and female condoms, as well as lactational amenorrhea method, which can be self-administered safely and effectively with enhanced awareness and minimal medical intervention.
Under the ‘Mission Parivar Vikas’ launched by the Government of India in 2016, self-care kits containing condoms, emergency contraceptive pills and pregnancy kits have been an important strategy to promote self-care among reproductive-age couples. In fact, the recent introduction of DMPA-SC (Subcutaneous Depot Medroxyprogesterone Acetate) marks a groundbreaking policy decision aimed at empowering women to make voluntary family planning choices. This method can not only be potentially self-injected, but women can also obtain them through multiple delivery channels (pharmacies) with multiple units/packets that can be supplied at one time, reducing the need for multiple contacts with health care providers. Thus, supported self-care interventions such as DMPA-SC will empower individuals to take greater control of their contraception and reproductive choices by facilitating increased availability, enhanced autonomy and privacy, reduced barriers, and an expanded basket of choice.
Advocating self-care and ensuring an enabling environment in which self-care interventions can be made available in safe and appropriate ways is important. Availability of new medical and digital technologies, goods, and services is essential to make an enabling environment for self-care to be able to make informed decisions about their reproductive lives, and act on them to achieve desired reproductive outcomes, free from biases, and retribution or fear. By embracing self-care as a viable option, we can break free from traditional norms and empower individuals with diverse contraceptive choices. In conclusion, reimagining contraceptive choices within the framework of self-care is essential for empowering individuals to make informed decisions about their reproductive health.
(This article has been authored by Aayushi Rastogi, Senior Manager and Manisha Choudhary, Research & Development Associate at Sambodhi Research and Communications, a Social Impact Advisory.)
Disclaimer: These are the personal opinions of the authors.
NDTV – Dettol have been working towards a clean and healthy India since 2014 via the Banega Swachh India initiative, which in its Season 10 is helmed by Campaign Ambassador Ayushmann Khurrana. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ population, indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In a world post COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental well-being, self-care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, which is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India.